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Use these tips to properly code anal fissure

APCs Weekly Monitor, May 4, 2007

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QUESTION: We have a problem coding procedures involving an anal fissure. There is a code for fistula but not fissure. What is the proper way to report this condition/procedure?

ANSWER: Both anal fistula and anal fissure have a specific ICD-9-CM diagnosis code. Code anal fistula using 565.1, and code anal fissure using 565.0

An anal fistula is an opening at, or near, the anus that usually, but not always, opens into the rectum above the internal sphincter. An anal fissure is a crack or slit in the mucous membrane of the anus which is painful and usually difficult to heal.

To locate the code for anal fissure in the ICD-9-CM alphabetic index, see the following:

fissure, fissured
anum, anal - 565.0
congenital - 751.5

For proper CPT code selection and APC assignment, report the appropriate code from the following range:

• 46200: Fissurectomy, with or without sphincterotomy, APC 00149, status indicator (SI) T
• 46257: Hemorrhoidectomy, internal and external, simple; with fissurectomy, APC 00149, SI T
• 46258: Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or without fissurectomy, APC 00149, SI T
• 46261: Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy, APC 00149, SI T
• 46262: Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy, APC 00149, SI T
• 46940: Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); initial, APC 00149, SI T
• 46942: Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); subsequent, APC 00148, ST T

Note that all these procedures fall into APC 149, except for 46492 (APC 148). National payment for APC 149 is $1368.78, relative weight 22.27. National payment for APC 148 is $312.07, relative weight 5.08.

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